Doctor's orders: Don't panic about flu

 

Related read: Teen fought off flu virus

It is likely to be an unusual flu season this year as the seasonal influenza viruses return amid a resurgence of the novel influenza A H1N1 pandemic, experts said.

With that in mind, people should not panic.

"I would tell folks at this point that their level of concern should not be a whole lot higher than it would be in any normal flu season," said James Wilde, an associate professor of pediatrics and emergency medicine at the Medical College of Georgia. "The biggest thing that we're going to see that is a little bit different with regard to this flu season is that it is probably going to start quite a bit earlier than usual."

Earlier this month, Emory University Hospital was still seeing five to 10 cases a week of the novel virus, said Bruce Ribner, an associate professor of medicine at Emory University School of Medicine. As of Aug. 15, two states were still reporting widespread levels of flu while Georgia was reporting the next lowest tier of activity -- regional -- and South Carolina had the tier below that -- local -- according to the U.S. Centers for Disease Control and Prevention. Almost all of that is probably the new virus -- 98 percent of the influenza A virus sub-typed by the CDC in the latest report was novel H1N1.

For an even better idea of what to expect in the months ahead, look south.

"If we look at the Southern Hemisphere for guidance, it is pretty nasty down there right now," Dr. Ribner said, particularly in Australia. "We have no reason to think we are going to get off any lighter than they are."

Though there is a large number of cases taxing the health care systems in those countries, the virus does not appear to be any more lethal than what has been circulating in the U.S. In fact, the CDC said the novel virus in the Southern Hemisphere looks similar to the strain from the U.S. used to help create the H1N1 vaccine being tested now.

That is good news for the United States because the strain has not yet acquired a virulence factor that has made past pandemic viruses, such as the 1918 Spanish flu, so deadly.

"It looks like what is going to come back across the equator is going to be more of the same," Dr. Ribner said. However, even a modest increase in patients could tax the health care system, which already operates close to capacity, he said.

THE GEORGIA DEPARTMENT of Community Health is trying to help do some of the pandemic flu planning now and prepare for worst-case scenarios, said Commissioner Rhonda M. Meadows.

The state has been planning since December 2005, but Dr. Wilde said no one anticipated the pandemic virus would turn out to be so relatively mild.

Still, the state is looking at things such as whether the virus becomes more virulent and whether alternative providers such as dentists, paramedics or veterinarians can be pressed into service to give shots, Dr. Meadows said. Legislation needed to allow an emergency expansion of practice will be drawn up just in case, she said.

The state is also making plans for a massive vaccination program and trying to get a handle on how many people would be in the groups targeted first, mainly children and pregnant women, Dr. Meadows said. There are about 2.5 million children in Georgia, according to the 2008 Census, and at any time about 180,000 women in Georgia are pregnant, Dr. Meadows said.

Schools are a consideration for vaccination sites, but the state is also looking at emergency room space in hospitals, Dr. Meadows said.

"We anticipate people are going to show up there," she said, "whether they are sick or not. They may just be scared. So having the emergency rooms maybe set aside some space to address that may be the smartest thing to do."

If a person is healthy and the infection seems to be running its normal course, an emergency room is the last place doctors want infected people to show up.

"Since this is not at this point a particularly dangerous virus, most people who get the infection do not need to see a doctor," Dr. Wilde said. "This is a viral infection that resolves on its own within usually four to six days, sometimes a little quicker."

"We'd like to preserve the medical system for those people who really need attention when the flu season increases," Dr. Ribner said.

The best thing to do now is to get a seasonal flu shot and prepare your family, Dr. Meadows said.

Though it is difficult for experts to predict what is ahead for seasonal flu and the new virus, it is likely to happen earlier, in September and October. And it is not anything to dread, Dr. Wilde said.

"Our actual mortality rate probably is no higher than seasonal flu and may be lower than seasonal flu," he said. "So in the same sense that folks shouldn't panic over the arrival of seasonal flu, they shouldn't panic over the prospect of their son or daughter at school getting H1N1 novel flu sometime in the next couple of months."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

ONLINE EXTRA

See a graphic explaining steps you can take to best protect yourself from the flu.

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SHOULD I GO SEE A DOCTOR?

If you or your child should become sick during the flu season, but remain otherwise healthy with no other conditions, it is probably not necessary to see a doctor or go to the emergency room, physicians said.

It is unlikely you will get a confirmatory test for the new virus from a provider because the Centers for Disease Control and Prevention is recommending that testing be done only on hospitalized and severely ill suspected cases of flu.

If the illness appears to be following its normal course, it is probably not necessary to seek anti-viral medication such as Tamiflu, said James Wilde, an associate professor of pediatrics and emergency medicine at the Medical College of Georgia.

At best, the medication will shorten the course of the illness by a day and a half, he said. Overuse of those medications can lead to resistance in the new influenza strain, which is already starting to crop up.

"And then folks who are very vulnerable are going to have no protection whatsoever against the virus," Dr. Wilde said.

The illness will usually last four to six days, sometimes less, and patients are asked to stay home until they have been free of fever for 24 hours. Get plenty of rest, and drink lots of fluids. Parents can give children Tylenol and Motrin to help combat fever but should not give them aspirin.

Bouts of vomiting and diarrhea are an unusual hallmark of this virus , and for that Dr. Wilde suggests a sports drink, such as Gatorade, that has both salt and sugar to aid rapid absorption. Even if the patient is still vomiting, taking small but steady amounts at a time should help ward off dehydration, he said.

 

 

When should parents take an otherwise healthy child to see a doctor?

- If the child develops problems breathing

- If the child cannot get out of bed

- If the child is vomiting and unable to take fluids to keep hydrated

- If the fever lasts longer than five days

Some should always see a doctor if they develop flulike symptoms, including:

- Pregnant women

- Patients with severe respiratory diseases (asthma, cystic fibrosis)

- Patients with severe heart disease

- Cancer patients, AIDS patients or anyone who is immunocompromised

- Renal dialysis patients

- Children younger than 2

 

WHO SHOULD GET WHICH SHOT?

SEASONAL

The seasonal flu vaccine is recommended for anyone who wants to avoid getting the flu. In particular, the vaccine is recommended for:

- Children 6 months to 19 years old

- Pregnant women

- People who are 50 or older

- People with underlying medical conditions that put them at greater risk of flu, such as asthma or diabetes

- Household contactsof infants less than 6 months old

- Health care workers and those who care for or live with someone at high risk of flu

H1N1

The vaccine will be targeted at five primary groups:

- Pregnant women

- Those who live with an infant younger than 6 months

- Health care workers and emergency medical services personnel

- Those 6 months to 24 years old

- Adults with underlying health problems that put them at greater risk for complications from flu, such as diabetes or lung disease

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